Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2022 Nov;29(12):7769-7778. doi: 10.1245/s10434-022-12064-4. Epub 2022 Jul 13.
When a positive sentinel lymph node (SLN) is identified after neoadjuvant chemotherapy (NAC), completion axillary lymph node dissection (cALND) is generally recommended. We sought to evaluate the rate of non-SLN positivity and factors influencing this in patients with a positive SLN following NAC.
We identified all patients at our hospital between 2006 and 2021 with a positive SLN (> 0.2 mm) following NAC who underwent cALND. Rates of positive non-SLN (NSLN) on cALND were compared by nodal status. Chi-square tests and multivariable logistic regression were used to assess factors predictive of positive NSLN and overall nodal burden.
Overall, 229 cases (177 cN+, 52 cN0 prior to NAC) with positive SLN(s) after NAC underwent cALND. Additional NSLN involvement was found in 129/229 (56.3%) patients, including 24/52 (46.2%) cN0 and 105/177 (59.3%) cN+ patients (p = 0.09). There was a trend for patients with SLN micrometastases to be less likely to have positive NSLN(s) than those with SLN macrometastases (38.5% vs. 58.6%; p = 0.05). Subgroup analyses showed no clinicopathologic factors significantly associated with additional axillary involvement for initially cN0 patients. Factors found to significantly influence NSLN positivity in the initially cN+ subgroup were HER2 status, multicentricity/multifocality, number of positive SLNs, and size of SLN metastasis. SLN metastasis size > 5 mm and three or more positive SLNs exerted the greatest influence on NSLN positivity.
Rates of nodal positivity on cALND in the setting of positive SLN after NAC are high, supporting the current standard of routine cALND. In cN+ disease, NSLN positivity varies by tumor biology, multicentricity/multifocality, number of positive SLNs, and SLN metastasis size.
新辅助化疗（NAC）后若检出阳性前哨淋巴结（SLN），通常建议行完整腋窝淋巴结清扫术（cALND）。我们旨在评估 NAC 后 SLN 阳性患者 cALND 中，非 SLN 阳性率及影响该阳性率的因素。
我们在我院回顾性分析了 2006 年至 2021 年间所有 NAC 后 SLN 阳性（>0.2mm）并接受 cALND 的患者。通过淋巴结状态比较 cALND 中非 SLN（NSLN）阳性率。卡方检验和多变量逻辑回归用于评估预测 NSLN 阳性和总体淋巴结负荷的因素。
共有 229 例（NAC 前 cN+177 例，cN0 52 例）NAC 后 SLN 阳性患者接受了 cALND。229 例患者中有 129 例（56.3%）检出额外的 NSLN 累及，其中 24 例（46.2%）为 cN0 患者，105 例（59.3%）为 cN+患者（p=0.09）。SLN 微转移患者 NSLN 阳性率低于 SLN 宏转移患者（38.5% vs. 58.6%；p=0.05），但差异无统计学意义。亚组分析显示，cN0 患者的临床病理因素与腋窝淋巴结转移无显著相关性。cN+患者的临床病理因素中，HER2 状态、多中心/多灶性、阳性 SLN 数量和 SLN 转移灶大小与 NSLN 阳性显著相关。SLN 转移灶大小>5mm 和 3 个及以上阳性 SLN 对 NSLN 阳性的影响最大。
NAC 后 SLN 阳性患者行 cALND 的淋巴结阳性率较高，支持目前常规行 cALND 的标准。在 cN+疾病中，NSLN 阳性率因肿瘤生物学、多中心/多灶性、阳性 SLN 数量和 SLN 转移灶大小而异。
